Epilepsy: Strategies for teachers
Introduction
Epilepsy is not a disease, but a malfunction of the electrical pathways in the neurons
(nerve cells) of the brain. Epileptic seizures are a result of these neuro-electrical
irregularities in the brain neurons. Anti-convulsant medication can either completely or
partially control seizures in approximately 80 percent of the epileptic individuals. A
major problem with epileptic students whose seizures are not completely controlled by
medication is the non-predictability of the occurrence of seizures.
General Strategies
 Bring to the student's attention role models with a similar disability. Point out that this
individual got ahead by a combination of effort and by asking for help when needed.
 During a student's epileptic seizure, the first rule is for you to remain calm.
 There is nothing you can do to stop the seizure once it has begun.
 Do not try to restrain the individual.
 If it is a convulsive seizure, lower the person to the ground or floor in a cleared area, if
possible, and clear the area of furniture or materials in order to avoid injury.
 Try not to interfere with movements in any way.
 Loosen ties and shirt collars, and place something soft under his/her head.
 When the person regains consciousness, reassure him/her and ask what additional
assistance is needed.
 If a seizure lasts longer than 10 minutes, or if multiple seizures occur without the
person regaining consciousness, treat it as a medical emergency and call 911.
 For a non-convulsive seizure, no medical action is typically needed. Stay with the
individual and gently guide them away from obvious hazards. Speak calmly and be
reassuringly to him/her.
 Stay with the person until they are completely aware of the environment around them.
Teaching Strategies
1. Children with "absence" seizures frequently blank out during the day causing
them to miss relevant instructions and content. Try to repeat instructions several
times or use a consistent 'step-by-step' strategy for them to follow.
2. Establish a 'buddy system' for the child with seizures. The buddy can answer
questions, and provide missed class work and homework.
3. Ask the child with epilepsy if they would prefer to sit at the front of the class to
aid in concentration.
4. Use physical prompts (pointing to a page, writing on the blackboard) to help
keep the student oriented.
5. After a seizure the child may be too exhausted to write a test or give a
presentation to the class. While it is important to maximize the amount of
instruction time by keeping the child in the classroom it may also be necessary to
modify expectations based on seizure activity.
6. Try to make the child's experience as 'normal' as possible. It is important not to
be overprotective, or to allow exemptions or restrictions in the early years to
damage a child's emotional growth.
7. Do not allow the child to carry out any activity more than 1 m (3') off the
ground, e.g. gym class, in the playground.
8. Children should be allowed to go swimming, but with adult supervision.
Seizure Disorder
In event of grand mal seizure, the student may experience moderate to severe conditions
of muscle contraction, twitching and limb jerking.
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Keep calm and remove surrounding objects that might injure the student.
Call for medical help or ask someone to call.
Do not restrain bodily movements or force anything between the student's teeth.
Lower the person to the floor, lay head on cushion and turn it sideways.
1. Children with "absence" seizures frequently blank out during the day causing
them to miss relevant instructions and content. Try to repeat instructions several
times or use a consistent 'step-by-step' strategy for them to follow.
2. Establish a 'buddy system' for the child with seizures. The buddy can answer
questions, and provide missed class work and homework.
3. Ask the child with epilepsy if they would prefer to sit at the front of the class to
aid in concentration.
4. Use physical prompts (pointing to a page, writing on the blackboard) to help
keep the student oriented.
5. After a seizure the child may be too exhausted to write a test or give a
presentation to the class. While it is important to maximize the amount of
instruction time by keeping the child in the classroom it may also be necessary to
modify expectations based on seizure activity.
6. Try to make the child's experience as 'normal' as possible. It is important not to
be overprotective, or to allow exemptions or restrictions in the early years to
damage a child's emotional growth.
7. Do not allow the child to carry out any activity more than 1 m (3') off the
ground, e.g. gym class, in the playground.
8. Children should be allowed to go swimming, but with adult supervision.
Watch for Signs of Depression
Depression is quite common in children who have epilepsy. It may be a
side effect of medication, or be caused by other factors such as stress,
major disappointment, or chemical imbalance in the body. The diagnosis
itself is incredibly overwhelming for a child!
Depression can have a major impact on a child's life. It's important to be
aware of the possibility that the child with a seizure disorder may feel
depressed.
Teachers, please look for these signs in the classroom and report them to
the child's parents:
EmotionalThe child may exhibit a troubled and unhappy state of
changes:mind. The child may feel worried, guilty, angry, fearful,
helpless, lonely, and be quiet or withdrawn.
IntellectualThe child may have trouble concentrating or experience
changes:chronic negative thoughts. Look for a child who was a
good student but suddenly receives poor marks.
PhysicalThe child may complain of headaches or general aches and
changes:pains. He may be unmotivated, and lethargic. The child
may also develop eating problems.
BehaviouralThe child may withdraw from others and not want to
changes:interact with friends, play or take part in fun activities he or
she used to enjoy. The child may cry easily and display
angry or aggressive behaviours.
Emergency and First Aid Action!
When to call
9-1-1
Does the child have a history of seizures? Call for help when the child
who has no known history of seizures has one.
Confusion after a seizure is always common.
Always notify parents if their child has a seizure, unless the seizure is a
brief blank spell.
When a seizure lasts for more than 5 minutes, or appears to end and then
starts again – seek medical assistance. This may be a condition called
status epilepticus – a life threatening medical emergency.
When a child is physically hurt during a seizure (cuts head, falls off play
equipment, burns hands).
When a seizure is in the water – inhaling water can cause heart or lung
damage.
Epilepsy and Learning
Epilepsy is a chronic disorder. The occurrence and frequency of seizures are
unpredictable. The Child, the family, and the teacher must learn to live with this
uncertainty, and not let fear of a seizure interrupt a normal life.
Children with epilepsy exhibit the same wide range of intelligence and ability as other
children. Children don't require special education simply because they have epilepsy.
Some children with epilepsy may require it just as some children without epilepsy will
require it. Many children do need extra support because of the side effects of their
medications and other brain anomalies. Some neurological disorders that cause epilepsy
may also cause learning difficulties.
In the early years severe, frequent seizures can affect the learning process, causing
cognitive delays. In the school years, absenteeism can impact the learning process by
causing the child to miss socialization opportunities and class instruction.
Children also feel tired after nocturnal or frequent seizures.
Psychosocial effects of seizures, including feelings of lack of control, poor self image,
poor attitude toward school and social problems can affect school performance.
Negative reactions from peer groups and teachers to epilepsy can adversely affect the
child with a seizure disorder.
Possible Seizure Triggers at School
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Not taking medications properly
Stress generated by change
Poor diet and eating habits
Stress, excitement, & emotional upset
Lack of sleep
Inactivity and boredom – research has shown that
individuals who are isolated and overprotected are
more likely to have a seizure
Television, videos, computer screens, and flashing
lights, or anything with a strobe effect can trigger
seizures
Memory and Concentration: Essentials for School
There is no cure for epilepsy. Seizures can be controlled in an estimated
80% of all cases by the use of anti-convulsant medication, and in 70-80%
of children the epilepsy resolves after a few years.
Possible Side Effects of Medications:
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Learning Capacity: concentration, short term memory loss
Alertness: hyperactivity, drowsiness, fatigue
Motor Capacity: hand, eye, balance, speech co-ordination
General well-being: unsteadiness, vomiting, dizziness
Mood changes: depression, aggressiveness, anti-social
behaviours
Toxicity: liver damage, anemia
Seizures Come in Many Shapes and Sizes
Absence Seizures
These are common in children and are often associated with learning difficulties.
This seizure type is often undiagnosed.
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Simple
Partial
Seizures
This seizure type looks like a staring spell or daydreaming.
The student experiences a brief loss of consciousness accompanied
by eye blinking, slight muscle movements around the mouth, or
arm movements.
These seizures usually last 2-10 seconds but happen frequently
throughout the day.
After the seizure, the child will immediately regain full awareness
and be able to resume full activity.
Often go undiagnosed until a more significant seizure occurs.
What You Can Do to Help
Inform the parent that
you believe the child
may be having this type
of seizure.
Let the student know
what they missed from
the lesson/activity once
he or she regains
awareness.
Pair the student up with
a buddy who can help
fill in the gaps.
Repeat all expectations
& instructions several
times.
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These seizures are limited to one area of the brain.
The student will not lose consciousness during a seizure
The child's senses could be distorted causing him to see, hear, or
smell experiences that are not real.
He or she may have unusual feelings.
This type of seizure usually lasts 1-5 minutes although it may last
longer.
One or more limbs may have jerky movements which cannot be
stopped.
It may be necessary to comfort and reassure the child.
Complex Partial Seizures
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These seizures may cause the child to express a variety of
inappropriate automatic behaviours such as tapping the desk,
picking at clothes, making chewing movements, or wandering
around.
Student loses awareness of surroundings.
This type of seizure usually lasts 1 to 5 minutes.
Recovery will be gradual and the child may feel confused for a
while after a seizure.
Child cannot recall what happened during a seizure.
What You Can Do to Help
If the child wanders, gently lead him
back to his seat.
Speak to the child calmly and reassure
him or her.
Do not grab the student or speak loudly.
Guide the child away from obvious
hazards such as stairs, play equipment,
or Bunsen burners.
If the child is confused afterwards, help
to re-orient him.
Generalized Tonic-Clonic Seizures
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At the start of a seizure, the child will cry out as the chest
muscles contract, forcing air out of the lungs.
The student will fall unconscious, his/her muscles will
stiffen and then the extremities will jerk and twitch.
The child may lose bladder and/or bowel control.
The eyes may roll back and the child may drool.
If the student bleeds from the mouth, it's probably because
he or she has bitten his/her tongue.
Breathing may be shallow or even stop temporarily, then
return once the jerking movements stop. This will cause
the pulse to be weak and skin and lips to turn bluish – but
colour will come back.
These seizures usually last a few minutes but they may last
considerably longer.
The child may be confused and tired after the seizure.
What You Can Do to Help
Do NOT put anything in the
child's mouth.
Do not restrain the child.
Move the child away from
furniture or any other object
which may harm them.
Turn the child on his/her side to
keep the air passage clear after
the seizure is over.
Place a pillow or jacket
(whatever is handy) under the
child's head.
Try to provide a sense of
security (talk in a calm voice).
Let the child rest after the
seizure is over.
If the seizure lasts more than 5
minutes, phone for an
ambulance.
Note the time the seizure starts
and ends.